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<br /> <br />PLEASE CmlPlETE THE fORt'uDO NOT WRITE <br /> <br />"See Atteched". <br /> <br />OOLY ~ FORMS AmYIW. <br /> <br />..... <br />RICE CREEK WATERSHED DISTRICT <br />SUITE 374, ARDEN PLAZA <br />3585 NORTH LEXINGTON AVENUE <br />ARDEN HILLS, MINNESOTA 55126 <br /> <br /> <br />(For 0 ce <br />PERMIT APPLICATION <br />Rec'd Office <br />Notice Sent <br />Agenda <br />AdminiE~rative Fee <br /> <br />Engr. <br /> <br />PERMIT APPLICATION <br /> <br />To be completed by the applicant <br />Phoen,x Homel,fe Mutual Insurance Co. <br />Owner: c/o Everest Property Management Datel 11/12/92 <br /> <br />Address: 2585 long lake Road <br /> <br />City: Roseville, MN 55113 <br />(zip code) <br /> <br />Permit Application for Approval ofl RemarKS I <br /> <br />o Comprehensive Stormwater Request for renewal of Permit fI <br />Management Plan <br />~' Land Development Plan . <br />Final Site Drainage Plan <br />Tlqa and/or Appropriation <br />of Public Waters <br />~ Bridge and/or Culvert Construction <br />Wetland Alteration <br />Shore1and (Riparian) Improvement <br />x Private Drainage SY6tem <br />Other (explain in Remarks) <br /> <br />Name of Project: <br /> <br />Watersedqe <br /> <br />Pur po s e 0 f Pro j '" c t ; Par k , n 9 lot ex pan s , 0 n <br /> <br />Location of Project-Address: <br /> <br />1500 County Road B2 <br />Rosevil1e, Minnesota <br /> <br />Municipality or Township: <br /> <br />sw <br /> <br />1/4 of Section <br /> <br />Rangt: 23W <br /> <br />To.....nship 29N <br /> <br />10 <br /> <br />Call 483-0634 if assistance in completing this form is required. Please <br />attach drawings, plans and other data as outlined in "Rice Creek.~atershed <br />District Permit Information Brochure~ available upon request. ~ail or <br />deliver this form along with a ~60 fee ($10 ~dministratiYe fee end $50 for <br />two inspections) and two sets of app~opriate ~xhibit~ to the~bove address. <br />Engineering review fees will be ~il1ed .after final Bo~rd action. <br />"A field inspection fee on this permit shall be ch3!'gecl t.o cover actual coste <br />related to a field inspection including the investigation of the area <br />affected by the proposed actLfity, analysis of the proposed activit.y, <br />se.vices of a consult.ant and in addition, n fee will be charged for any <br />required subsequent monitoring of t.he propused activity." M.S.A. 112.88, <br />Subd. 2. App!ying for this permit to RCW[J does Ilut precJ ude your C1pp1ying <br />for any necessary permits tnat may be required from other governmental <br />agencies. <br /> <br />1\8-78 <br /> <br />Rev leed 1/1/91 <br />